Skip to main content

A randomized clinical trial of supported employment for inner-city patients with severe mental disorders (Drake et al. 1999)

Absence of conflict of interest. 

Citation

Drake, R. E., McHugo, G. J., Bebout, R. R., Becker, D. R., Harris, M., Bond, G. R., & Quimby, E. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Archives of General Psychiatry, 56(7), 627-33.

Highlights

  • The study’s objective was to examine the impact of Individual Placement and Support (IPS) services on employment and earnings outcomes.
  • The study was a randomized controlled trial that assigned participants to the IPS treatment group or Enhanced Vocational Rehabilitation (EVR) control group. Using assessment data and statistical models, the authors compared the outcomes of treatment and control group members.
  • The study found that treatment participants had significantly higher employment rates than control participants.
  • This study receives a high causal evidence rating. This means we are confident that the estimated effects are attributable to the Individual Placement and Support (IPS) services, and not to other factors.

Intervention Examined

Individual Placement and Support (IPS)

Features of the Intervention

Individual Placement and Support (IPS) is a supportive employment approach for participants with severe mental illness designed to help attain employment. Employment specialists within a mental health center assisted participants in directly obtaining competitive employment, while also providing ongoing support. The program served unemployed adults with a severe mental disorder and lack of memory impairment or medical illness that would prevent employment or participation in study interviews. The IPS model used a combination of participant preferences, vocational assessment, job development, and optional interview accompaniment to provide individualized and rapid job-search assistance. There was no time-limit for these services and employment support was given as needed.

Features of the Study

The study was a randomized controlled trial that assigned 152 participants to the treatment or control group (76 participants in each group). During an 18-month period from January 1994 to July 1995, participants were recruited from Community Connections, an agency in Washington, DC that serves patients with severe mental disorders. Study participants were unemployed adults with a severe mental disorder. Over 50 percent of the treatment and control group were female, with the majority of participants African American by race. The majority of both groups had attained a high school diploma or higher, were never married, and were diagnosed on the Schizophrenia spectrum. The treatment participants were slightly younger and had a higher rate of current drug use when compared to their control counterparts. Participants in the treatment group received IPS programming from IPS employment specialists. Participants in the control condition received Enhanced Vocational Rehabilitation (EVR) programming from well-established VR agencies to seek employment using a more traditional supportive approach to employment. The primary data sources were baseline and bi-monthly assessments measuring study outcomes related to competitive employment and income. Assessments of study outcomes were conducted at baseline and 6-, 12-, and 18-month follow-up periods. The authors used statistical models to compare the outcomes of treatment and control group members.

Findings

Earnings and wages

  • The study did not find a significant difference in total earnings between treatment and control group participants.

Employment

  • The study found that a significantly higher proportion of treatment participants (61 percent) found competitive employment relative to control participants (9 percent).
  • For individuals who were employed, the study also found that treatment participants worked on average more hours, more weeks, and found employment faster than control participants. These differences were significant.

Considerations for Interpreting the Findings

The study authors identified differences in approaches to mental health services that may have impacted employment outcomes. Since the IPS treatment provider organized employment and mental health services from one source, the mental health and employment treatment plans may have been better coordinated to achieve increased rates of employment. Study authors compared this to the EVR approach that provided employment services internally, but outsourced mental health services for participants. Therefore, employment and mental health treatment plans may not have overlapped in effective ways to increase employment rates in the EVR control group.

Causal Evidence Rating

The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that the estimated effects are attributable to the Individual Placement and Support services, and not to other factors

Reviewed by CLEAR

July 2022

Topic Area